Triplets in utero
Twins, Triplets, Complications & Symptoms
What is a multiple pregnancy?
A multiple pregnancy is a pregnancy where you’re carrying more than one baby at a time. If you’re carrying two babies, they are called twins. Three babies that are carried during one pregnancy are called triplets. You can also carry more than three babies at one time (high-order multiples). There are typically more risks linked to a multiple pregnancy than a singleton (carrying only one baby) pregnancy.
How do multiple pregnancies happen?
There are two main ways that a multiple pregnancy can happen:
- One fertilized egg (ovum) splits before it implants in the uterine lining.
- Two or more separate eggs are fertilized by different sperm at the same time.
These two different types of multiple pregnancy result in either identical or fraternal siblings. The difference between identical and fraternal babies goes back to how the multiple pregnancy happens.
Identical twins or triplets happen when a single egg is fertilized and then later splits. These newly divided embryos are identical. Children that are identical multiples will look like each other and be the same sex.
Fraternal multiples develop from separate eggs that are fertilized by a different sperm. Because these are different eggs and different sperm, the genetic material is varied. These children won’t look identical and can be different sexes from each other.
In a pregnancy with triplets or more, your babies could be all identical, all fraternal or a mixture of both. This can happen if your body releases multiple eggs and more than one is fertilized. In a case where you have both identical and fraternal multiples, more than one egg was fertilized and then at least one of those eggs also split after fertilization.
Are identical twins or triplets always the same sex?
Because identical twins or triplets share genetic material, they are always the same sex. The sex of a baby is determined by the particular sperm cell that fertilizes the egg at conception. There are two kinds of sperm cells — those carrying an X chromosome or Y chromosome. The mother’s egg carries an X chromosome. If a sperm cell carrying an X chromosome fertilizes the egg, it will make a XX combination (female). If the sperm cell is carrying a Y chromosome, you end up with an XY pairing (male).
Identical multiples start as one egg and then split, so whatever chromosome combination is present at fertilization is the sex of all multiples.
What increases the chance of a multiple pregnancy?
There are several factors that can increase the risk of a multiple birth. You might be at a higher risk of getting pregnant with more than one baby at a time if you:
- Are older (women in their 30s are at a higher risk of multiples because the body starts to release multiple eggs at one time when you get older).
- Are a twin yourself or have twins in your family.
- Are using fertility drugs.
You might also be at a higher risk of a multiple pregnancy if you are taller than average or have a higher body weight.
Another risk factor for a multiple pregnancy is genetic. There is an increased possibility of a multiple pregnancy if you are a multiple yourself, or if multiples run in your family. This heredity trait is generally passed down through the maternal (mother’s) side of the family.
The use of fertility drugs can be another reason you might have a multiple birth. Treatments for infertility can increase your risk of a multiple pregnancy because procedures, like in vitro fertilization (IVF), often involve transferring more than one fertilized egg into your uterus. Your provider usually transfers more than one egg at a time to increase the odds of a successful pregnancy.
How common are multiple births?
Multiple births have become more common in recent years because more people are using fertility drugs and procedures, such as IVF, to help conceive a baby.
What are the signs of a multiple pregnancy?
The only way to know if you’re pregnant with more than one baby during your pregnancy is through an ultrasound exam with your healthcare provider. During this test, your provider can look at images of the inside of your uterus and confirm how many babies are in there.
You might experience more intense symptoms during a multiple pregnancy than with a single pregnancy. These can include:
- Severe nausea and vomiting (morning sickness).
- Rapid weight gain in the first trimester of pregnancy.
- Sore or very tender breasts.
- High human chorionic gonadotrophin (hCG) levels — this hormone is made during pregnancy and is what a pregnancy test picks up.
- High amounts of the protein alpha-fetoprotein in your blood.
Apart from an ultrasound, your provider might suspect multiples if there’s more than one heartbeat detected during a fetal Doppler scan.
What complications are linked to multiple births?
Anyone can experience complications during pregnancy — regardless of how many babies you’re carrying. However, most healthcare providers consider multiple pregnancies higher risk than single pregnancies. This doesn’t mean that every woman who carries more than one baby during a pregnancy is going to have problems. If you’re pregnant with multiples, your provider will want to watch you for possible complications that can happen when you carry more than one baby at once. Your provider will talk to you about each risk factor and frequently check with you to make sure you aren’t experiencing anything concerning.
Possible complications include:
- Premature labor and birth: The most common complication of multiple births is premature labor. If you’re pregnant for multiples, you are more likely to go into premature labor (before 37 weeks) than a woman carrying only one baby. The goal for many moms of multiples is to complete 37 weeks. This is considered term in a twin pregnancy and reaching this week of gestation increases the chance the babies will be born healthy and at a good weight. Babies that are born prematurely are at risk of another complication of multiple births — low birth weight.
- Preeclampsia or gestational hypertension (high blood pressure): High blood pressure is called hypertension. During pregnancy, your healthcare provider will watch your blood pressure carefully to make sure you don’t develop gestational hypertension (high blood pressure during pregnancy). This can lead to a dangerous condition called preeclampsia. Complications related to high blood pressure happen at twice the rate in women carrying multiples compared to women pregnant with only one baby. This complication also tends to happen earlier in pregnancy and be more severe in multiple pregnancies than single pregnancies.
- Gestational diabetes: You can develop diabetes during pregnancy. This happens because of the increased amount of hormones from the placenta. The size of the placenta can also be a factor in this condition. If you have two placentas, there’s an increased resistance to insulin.
- Placenta abruption: This condition happens when the placenta detaches (separates) from the wall of your uterus before delivery. This is an emergency situation. Placenta abruption is more common in women who are carrying multiples.
- Fetal growth restriction: This condition can also be called intrauterine growth restriction (IUGR) or small for gestational age (SGA). This condition happens when one or more of your babies is not growing at the proper rate. This condition might cause the babies to be born prematurely or at a low birth-weight. Nearly half of pregnancies with more than one baby have this problem.
Fraternal twins always have two placentas. The risks of pregnancies with fraternal twins are similar to those of pregnancies with only one baby. However, the number of possible risks are increased when compared to pregnancies with one baby.
Identical twins may have one placenta (70% of the cases) or two placentas (30% of the cases). The risks of identical twins with two placentas are similar to those listed above for fraternal twins. Identical twins with one placenta (called monochorionic) have risks that are unique to them. In 5 to 15% of the cases, they may develop a condition called twin-twin-transfusion-syndrome (TTTS). This is the consequence of vascular communications at the placenta level between the twins. Due to these communications, the twins may share their blood. When this happens — if nothing is done — there is a 90% risk that the twins will die in-utero. In-utero procedures are performed to decrease the fetal death risk for the twins.
Another complication that can happen in identical twins with one placenta is called twin-anemia-polycythemia sequence (TAPS). This is due to blood that goes from one twin to the co-twin because of vascular communications at the placental level. In this condition, one twin becomes anemic (low red-blood cells), whereas the co-twin becomes polycythemic (too many red-blood cells). Several treatments/interventions are performed when this happens.
A third condition that can occur in identical twins with one placenta is called” selective IUGR”. One twin grows well, whereas the co-twin does not experience much growth.
Another condition typical of identical twins is called twin-reversed-arterial-perfusion syndrome. In this condition, the heart of one twin pumps blood for the circulation of both twins. One twin does not have the heart and will not survive following birth. The outcome of the twin with the normal heart varies. Fortunately, this syndrome is rare (1 in 20,000 to 40,000) and it is amenable to in-utero procedures.
Identical twins with one placenta may also be in the same sac. They are called monochorionic (one placenta)-monoamniotic (one gestational sac). This pregnancy occurs in 1% of multiple gestations and it’s associated with an increased risk for one or both twins.
Your healthcare provider will diagnose the above conditions with an ultrasound.
Am I more likely to have a C-section delivery if I’m carrying multiples?
A cesarean section is a procedure used to deliver a baby through an incision (cut) in the abdomen. This type of delivery might be used for a variety of reasons, but it’s fairly common in multiple births. Your chance of having a C-section for a multiple birth is higher than if you were pregnant for only one baby. However, even in single births, a C-section can sometimes be the safest option for delivery.
Often, the babies aren’t in the right position for birth — head down. A C-section can also happen if you have a complication during pregnancy that means a vaginal birth isn’t the safest option for you or your babies. Your healthcare provider will monitor you leading up to your due date and talk to you about the best option for delivery.
What can I do to stay healthy during a multiple pregnancy?
Eating nutritious foods, getting enough rest, and visiting the doctor regularly are important steps for any pregnant woman to take toward a healthy pregnancy. These steps are especially important during multiple pregnancies.
If you’re expecting multiples, you have additional dietary needs to meet. Getting enough protein and enough hydration (fluids) is important. You’ll also need to make sure you get enough extra calories for the developing fetuses. One rule of thumb is to eat an extra 300 calories a day per baby. That means that if you’re pregnant with twins, you will need to add 600 calories to your daily diet. Talk to your healthcare provider about your diet and the specific amounts you’ll need for a healthy pregnancy.
Moms of multiples might also experience the typical discomforts of pregnancy more intensely. It’s important to take good care of yourself and get plenty of rest to help ease the stresses of pregnancy.
In some cases, you might want to find a healthcare provider who has experience with multiple births. Specialized healthcare can help ensure that you and your babies are receiving the best care available. The need for frequent, intensive prenatal care is very important in a multiple pregnancy. Talk to your family doctor or OBGYN about their recommendations for specialists.
Can I be active and exercise during a multiple pregnancy?
Exercise and activity is an important part of any pregnancy. In most cases, you can absolutely exercise during a multiple pregnancy. Low-impact exercises are a great way to stay in shape and maintain your health throughout pregnancy. Some low-impact exercises to try during a multiple pregnancy can include:
- Swimming.
- Walking.
- Prenatal yoga.
Even though activity is wonderful during pregnancy, you should talk to your healthcare provider about the best activities for you. Some more strenuous activities might not be a good idea during a multiple pregnancy, including:
- Jogging.
- Aerobics that involve jumping.
It’s also important to remember that your exercise routine might need to change over time if you experience any complications.
Types of multiple pregnancy | Pregnancy Birth and Baby
Types of multiple pregnancy | Pregnancy Birth and Baby beginning of content5-minute read
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A multiple pregnancy is when you are pregnant with more than one baby. You might be expecting twins, triplets or more!
In Australia, about 3 in 100 births are multiple babies. And most of these are twins.
How do multiple pregnancies occur?
Multiple pregnancies occur when more than one embryo implants in your uterus (womb). This can happen:
- if you release more than one egg during your menstrual cycle and each egg is fertilised by a sperm
- your fertilised egg splits into 2, resulting in 2 identical embryos
Multiple pregnancies are more common than they used to be. This is mainly because of the increasing use of in vitro fertilisation (IVF). The fertility medicines used in IVF often cause more than one egg to be released from the ovaries.
Sometimes with IVF, more than one fertilised embryo is transferred to the uterus. This can result in a multiple pregnancy.
Another way a multiple pregnancy can occur is if one of the transferred eggs splits in two. This results in twins.
Women aged 35 years and older are more likely to release more than one egg when they ovulate. This means that you are more likely to have non-identical twins as you get older.
You are also more likely to have a multiple pregnancy if there is a history of non-identical twins on your mother’s side of the family. Identical twins do not run in families.
Diagnosis of multiple pregnancy
Signs that you might be expecting multiple babies include:
- you seem bigger than you should be for your dates
- twins run in your family
- you have had fertility treatment
A multiple pregnancy is confirmed by an ultrasound scan. This is usually in the first trimester (the first 12 weeks of pregnancy).
The ultrasound will confirm the type of multiple pregnancy. This includes:
- the number of placentas
- the number of amniotic sacs
These are all important factors for later in the pregnancy. It's important to identify these factors as early as possible.
If you are carrying multiple babies, you will have to see your doctor or midwife more often than someone who is expecting one baby.
Most multiple pregnancies progress smoothly. However, there's a higher chance of your babies:
- being born prematurely
- having a low birth weight
You may also have complications with your pregnancy, such as:
- gestational diabetes
- pre-eclampsia
- premature labour
- bleeding
Types of multiple pregnancy
The most common type of multiples include the following.
Fraternal twins
Two separate eggs are fertilised and implant in the uterus.
Your babies are:
- siblings
- share the same uterus
- may look similar or different
- may be the same gender (2 girls or 2 boys) or different genders (a boy and a girl)
A pregnancy with fraternal twins has the lowest risk of all multiple pregnancies. This is because each baby has its own placenta and amniotic sac.
You will sometimes hear fraternal twins referred to as 'dizygotic' twins. This refers to 2 zygotes (fertilised eggs).
Identical twins
Identical twins are formed when a single fertilised egg splits in 2.
Each embryo is genetically identical, so the babies share the same DNA. That means that your babies will share many characteristics. But sometimes identical twins can look quite different. This is because their appearance is also influenced by the environment.
Identical twins may:
- share the same placenta and amniotic sac
- share a placenta but have their own amniotic sac
- have their own placenta and amniotic sac
You will sometimes hear identical twins referred to as 'monozygotic'. This refers to one zygote (fertilised egg).
Triplets and 'higher order multiples' (HOMs)
Triplets, quadruplets, quintuplets, sextuplets or more can be a combination both of identical and fraternal multiples.
For example, triplets can be:
- fraternal (trizygotic), forming from 3 individual eggs that are fertilised and implant in your uterus
- identical, when one egg divides into 3 embryos
- a combination of both fraternal and identical babies
Getting support
If you are having multiple babies, you will need a lot of support throughout your pregnancy and after the babies are born.
For support and resources, you can contact the Australian Multiple Birth Association. You can also call Pregnancy, Birth and Baby on 1800 882 436 for advice or support.
Speak to a maternal child health nurse
Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week.
Sources:
AIHW (Mothers who have multiple births and their babies), NHS (Pregnant with twins), Royal College of Obstetricians and Gynaecologists (Multiple pregnancy: having more than one baby)Learn more here about the development and quality assurance of healthdirect content.
Last reviewed: June 2022
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Do you think they shot back? Mothers of triplets about dangerous pregnancy and parenting
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Society
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News heirs in the family - not such a rare occurrence! True, as practice shows, such pregnancies are very difficult, and we are talking about serious risks for both unborn children and women carrying them.
April 19, 2021 08:3014 542
Ekaterina Zenyakina with her triplets sons Semyon, Mark and Miron ' is irrelevant to them.
Ekaterina Zenyakina, 30 years old, Moscow
Katya could not even think that she would become a mother of many children overnight, but it so happened that she gave birth to beautiful triplets Semyon, Mark and Miron, who are 4.5 years old today. Having learned about a multiple pregnancy at an appointment with an uzist, Zenyakina was not afraid of the hassle.
“I once read that many mothers, upon learning about triplets, immediately begin to fear that they will not cope. I didn't worry about this at all. There was only one thought in my head - to bring the babies to a normal term, and so that they would be born healthy. Immediately after the birth, the boys were in intensive care, then they were transferred to the second stage of nursing. In total, they spent their first 1.5 months in the maternity hospital. Here, no help was required - everything lay on the shoulders of doctors and nurses. I came to feed the guys and talk to them. She moved away from the caesarean section quickly - a week after giving birth she was already running, ”Ekaterina shared with StarHit.
As for the pregnancy, according to Zenyakina, it was difficult. “From the 10th week until the very end, I was accompanied by a terrible tone of the uterus from any physical activity. Until the 18th week, bleeding occurred periodically, so I almost constantly lay, afraid of premature birth (there are too big risks with triplets). A bunch of pills and droppers, intercostal neuralgia, which tormented me for about a month ... I didn’t sleep at night because of this, it seemed that the ribs were moving apart. All this was joined by terrible swelling and high blood pressure. At 29week I was hospitalized with the threat of premature birth. At 31 weeks, I had an emergency caesarean,” she recalled.
Zenyakina and her husband did not even think that overnight they would become parents of many children
At first, Katya and her husband coped with the children on their own, with time close relatives came to the rescue. “It was not difficult, as the kids slept most of the time and ate every three hours. Difficulties arose only with night feeding. My parents also came to help in the evenings, and my grandmother Nina Afanasevna also came from the village. She lived with us for about a month and nursed her great-grandchildren with pleasure, ”said the mother of many children.
Anastasia Khasanova, 27 years old, Novosibirsk
Nastya did not plan to be a mother of many children either - she and her husband dreamed of having one child and could not even imagine that they would immediately receive three kids - Adeline, Amalia and Malik.
“On the first ultrasound I was told I had twins, two weeks later it turned out I had triplets… I panicked. I remember how with trembling hands I called my husband, he reassured me, saying that everything would be fine. The pregnancy was very difficult, but the doctors immediately warned me about it. From the 10th week I faced severe toxicosis, I lay under droppers for a month, I could not eat anything. This continued until 18 weeks, then it got better. I also had high blood pressure, I was constantly hospitalized. Every week it became hard physically - edema tormented me, my weight grew rapidly, which I could not control. Gained 35 kilos. I gave birth at 34 weeks, as Malik and Adelina squeezed Amalia in her stomach, and she had a bad heartbeat, ”said Anastasia.
Anastasia and her husband have two daughters and a son, who were born almost simultaneously
After giving birth, Nastya and her husband began a different life - the couple literally disappeared into the babies.
“In the first months I could sleep for two or three hours, I was like a terminator. I just could not believe that these three babies are mine! Happiness just overwhelmed me. Relatives even had to persuade me to lie down. The children are almost two years old, it has become much easier, but at each stage there are difficulties. Now it is interesting to watch them: they try to chat, show their character. They were born on the same day, under the same zodiac sign, but they are so different both in temperament and appearance! They even have different blood types and Rhesus ... At the moment we are not planning children, but! My husband and I are young and beautiful and, perhaps, in 10 years we will give birth again, ”the brunette admits.
Yulia Sungatova, 32 years old, Kazan
Yulia is very afraid of hospitals, doctors, so she decided for herself that if she becomes a mother, then only once. Everything turned out the way she wanted, however, at one time Sungatova gave birth to three babies at once - Theon, Demida and Gordeya!
“I am a terrible coward, I even donate blood with ammonia. Therefore, I always told everyone that I would give birth only once. The husband smiled maliciously, he had his own plans - he wanted three. On New Year's Eve, he wished to become a father of many children. And so it happened - one birth and three children. What happened to me when I found out about the multiple pregnancy? Shock. I heard about this only on TV and then, once every few years. At first I was overcome by wild fear, I really understood all the risks. After the emotions subsided, I was very happy, because this is such a miracle. The husband was not surprised, as if he knew everything in advance, ”Julia shared with StarHit.
The Sungatovs became parents of many children at once
Yulia managed to reach 35 weeks of pregnancy, of which she spent about a third in preservation. But the most interesting thing began after the birth of the kids.
“We slept, but that's not certain,” says a mother of many children. I vaguely remember that time. In the first month after discharge, my mother lived with us. Then the godmother. Then the mother-in-law came to help. The hardest thing was to feed everyone at the same time, since we have a regimen from birth. They ate badly, 100 milliliters of the mixture was stretched for an hour, or even more. Everyone was fed simultaneously every three hours, including at night. Husband slept in his arms with bottles. Zombie mode, in a word. Now the kids are 1.7. It has become easier, but at the same time more difficult. Total control. I can’t imagine how kindergarten teachers cope.”
Despite all the difficulties, the Sungatovs are ready to become parents again. “We would like a girl for good measure, in five years. But first you need to build a house, it is unrealistic to live in an apartment with such a company. If there were no problems with the health of one of the sons, then I would not have any difficulties. Due to the constant rehabilitation, the regimen gets lost, less attention can be paid to the rest. But, we believe that this is temporary. Soon everything will be fine, ”said Yulia.
Antonina Aksenova, 41, Kherson (Ukraine)
After the birth of her first-born son, Antonina did not even think about becoming a mother for the second time - the child grew restless, and the thought of a second pregnancy frightened her. But eight years passed, and the woman wanted to become a mother again - to give birth to a daughter. Imagine her surprise when it turned out on the ultrasound that she was expecting triplets!
“I will never forget this ultrasound! The doctor, examining me, said to the nurse: "Three." To be honest, I did not immediately understand what this figure means. I thought they were discussing something there. Then the doctor says to me: “Mommy, do you know that you will have triplets? Look...” And she brought to the screen, the first fruit, the second, the third. I was in shock: how, where? We did not have multiple pregnancies in our family ... I went home from the reception, I had a state of stupor, I did not know what to say to my relatives, to my spouse. Arriving home, I called my husband, saying, they say, do you know how many more children you will have? He was delighted, answers - two, but I say - no, and how she burst into tears. He began to reassure me, they say, we’ll break through, and it’s great to give birth to three at once, ”recalls Antonina.
For some time Aksyonova was worried that she would not be able to cope with the children after the birth, but over time, all worries disappeared, and she simply enjoyed her condition.
Aksenov's triplets were born in autumn 2014
Antonina was lucky to bring babies up to 38 weeks. “The pregnancy went perfectly, all the tests were normal, I busied myself around the house to the last, my husband, of course, scolded me, but I am such a bee - I love order and comfort very much. Usually with multiple pregnancies often women lie on the conservation. Thank God, this fate has passed me. At the end of my pregnancy, I couldn’t sleep lying down, all my organs were tightened up, I dozed while sitting. The doctor said at 38 weeks, they say, we will do a caesarean section, pulling is risky, since this is a very good time for a multiple pregnancy, ”she said.
On September 3, 2014, the Aksenova triplets, Darina, Alexander and Polina, were born.
“Children immediately began to breathe on their own, each of them had a good weight, everything was normal. And we were discharged home on the third day. After giving birth, I did not recover immediately, after about six months my stomach “left”. Two grandmothers helped with the kids - my mother lived with us for seven months, and my mother-in-law came every day. My husband also joined after work. For the first two weeks, the children slept and ate well. Then our dream disappeared somewhere. They didn't want to sleep in their beds. I had to take it to myself: Sasha was under my husband’s wing, Polina was under my wing, and Darina was sleeping on the pillow in the middle - she was the calmest. They woke up at different times, respectively, I could not say that I had a night's sleep, my milk was gone. There was barely enough money to feed the kids and diapers, ”said the mother of many children, who managed to overcome all difficulties thanks to the support of loved ones.
Photo: personal archive
Text author: Marina Sattarova
Multiple pregnancy
Author: Mikheeva Natalya Grigorievna, Malyshok magazine
A multiple pregnancy is a pregnancy in which two or more fetuses develop simultaneously in the uterus. Multiple pregnancy occurs in 0.4 - 1.6% of all pregnancies. Recently, there has been an obvious trend towards an increase in the incidence of such pregnancies due to the active use of assisted reproduction technologies, including in vitro fertilization (IVF).
Types of multiple pregnancies
Children born in multiple pregnancies are called TWINS. There are two main types of twins: monozygotic (identical, homologous, identical, similar) and dizygotic (fraternal, heterologous, different). African countries have the highest twin birth rate, Europe and the USA have an average rate, and Asian countries have a low rate.
Dizygotic (fraternal) twins are more common (in 66-75% of all twins). The birth rate of dizygotic twins varies from 4 to 50 per 1000 births. Dizygotic twins occur when two separate eggs are fertilized. The maturation of two or more eggs can occur both in one ovary and in two. The predisposition to develop dizygotic twins may be maternally inherited. Dizygotic twins can be either same-sex or opposite-sex, they look like each other like ordinary brothers and sisters. With fraternal twins, two placentas are always formed, which can be very close, even touching, but they can always be separated. Two fruit spaces (i.e., fetal bladders or two “houses”) are separated from each other by a septum consisting of two chorionic and two amniotic membranes. Such twins are called dizygotic dichorionic diamniotic twins.
Monozygotic (identical) twins are formed as a result of the separation of one fetal egg at various stages of its development. The frequency of birth of monozygotic twins is 3-5 per 1000 births. The division of a fertilized egg into two equal parts can occur as a result of a delay in implantation (immersion of the embryo in the uterine mucosa) and oxygen deficiency, as well as due to a violation of the acidity and ionic composition of the medium, exposure to toxic and other factors. The emergence of monozygotic twins is also associated with the fertilization of an egg that had two or more nuclei. If the separation of the fetal egg occurs in the first 3 days after fertilization, then monozygotic twins have two placentas and two amniotic cavities, and are called monozygotic diamniotic dichoriones (Fig. A). If the division of the ovum occurs between 4 - 8 days after fertilization, then two embryos will form, each in a separate amniotic sac. Two amniotic sacs will be surrounded by a common chorionic membrane with one placenta for two. Such twins are called monozygotic diamniotic monochorionic twins (Fig. B). If division occurs by 9- 10th day after fertilization, then two embryos are formed with a common amniotic sac and placenta. Such twins are called monozygotic monoamniotic monochorionic (Fig. B) If the egg is separated at a later date on the 13th - 15th day after conception, the separation will be incomplete, which will lead to the appearance of conjoined (undivided, Siamese) twins. This type is quite rare, approximately 1 observation in 1500 multiple pregnancies or 1: 50,000 - 100,000 newborns. Monozygotic twins are always the same sex, have the same blood type, have the same eye color, hair, skin texture of the fingers, and are very similar to each other.
Twin births occur once in 87 births, triplets - once in 87 2 (6400) twins, quadruples - once in 87 3 (51200) triplets, etc. (according to the Gallin formula). The origin of triplets, quadruplets, and more twins varies. So, triplets can be formed from three separate eggs, from two or one egg. They can be monozygotic and heterozygous. Quadruples can also be identical and fraternal.
Features of the course of multiple pregnancy
In case of multiple pregnancies, the woman's body is subject to increased demands. All organs and systems function with great tension. In connection with the displacement of the diaphragm by the enlarged uterus, the activity of the heart becomes difficult, shortness of breath, fatigue occur. Enlargement of the uterus, especially towards the end of pregnancy, leads to compression of the internal organs, which is manifested by impaired bowel function, frequent urination, and heartburn. Almost 4-5 times more often there is the development of preeclampsia, which is characterized by an earlier onset, a protracted and more severe clinical course, often combined with acute pyelonephritis of pregnant women. Due to the increased need and consumption of iron, iron deficiency anemia often develops in pregnant women. Significantly more often than with a singleton pregnancy, complications such as bleeding during pregnancy and childbirth, anomalies in labor, and a low location of the placenta are observed. Often, with multiple pregnancies, abnormal positions of the fetus occur. One of the most common complications in multiple pregnancy is its premature termination. Preterm birth is observed in 25-50% of cases of such pregnancies.
The development of term twins is normal in most cases. However, their body weight is usually less (by 10% or more) than in singleton pregnancies. With twins, the weight of children at birth less than 2500 g is observed in 40-60%. The low weight of twins is most often due to insufficiency of the uteroplacental system, which is not able to adequately provide several fetuses with nutrients, trace elements and oxygen. The consequence of this is a delay in the development of the fetus, which is a common occurrence in multiple pregnancies. The mass of twins, respectively, decreases in proportion to their number (triplets, quadruplets, etc.).
With monochorionic twins in the placenta, anastomoses are often formed between the fetal vascular systems, which can lead to a serious complication - feto-fetal transfusion syndrome. In this case, there is a redistribution of blood from one fetus to another, the so-called "stealing". The severity of feto-fetal transfusion (mild, moderate, severe) depends on the degree of redistribution of blood through the anastomoses, which vary in size, number and direction.
Diagnosis in multiple pregnancy
The most reliable method for diagnosing multiple pregnancy is ultrasound, which allows not only early diagnosis of multiple pregnancy, but also to determine the position and presentation of fetuses, localization, structure and number of placentas, the number of amniotic cavities, the volume of amniotic fluid, congenital malformations and antenatal fetal death, the state of the fetus from a functional point of view, the nature of the uteroplacental and fetal-placental blood flow.
In multiple pregnancies, due to the higher risk of complications, ultrasound monitoring is performed more frequently than in singleton pregnancies. With dizygotic twins, about once every 3-4 weeks, with monozygotic twins - once every 2 weeks.
In addition, examinations and control of clinical tests are carried out with great care, and CTG is regularly recorded from 28 weeks of pregnancy.
Birth management
Indications for caesarean section associated with multiple pregnancies are triplets (quadruple), the transverse position of both or one of the fetuses, breech presentation of both fetuses or the first of them, and not associated with multiple pregnancy - fetal hypoxia, anomalies labor activity, prolapse of the umbilical cord, extragenital pathology of the mother, severe gestosis, placenta previa and abruption, etc.
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ECO
In the department of assisted reproductive technologies of the Maternity Hospital No. 2
, IVF is performed at the expense of the Republican budget for couples
who have received a positive decision from the Minsk city or regional commissions to provide one free IVF attempt.
No drug supply problem. There is no waiting list. -
Farewoman
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Individual care for patients
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Ultrasound diagnostics
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CONSTENTIONS OF THE RIGHT LIGHTS
9 9,000 90009 up to 80 million pairs of twins.
The number of twins born in relation to the total number of newborns in different countries and on different continents is different, but in general the trend is such that it continues to grow. Compared with the 60s, the percentage of twins has increased from 1.18 to 2.78, that is, almost 2.5 times.
The largest number of children
The largest number of children born to one mother, according to official data, is 69. According to reports made in 1782, between 1725 and 1765. The wife of a Russian peasant Fyodor Vasiliev gave birth 27 times, giving birth to twins 16 times, triplets 7 times and 4 twins 4 times. Of these, only 2 children died in infancy.
The most prolific mother of our contemporaries is Leontina Albina (or Alvina) of San Antonio, Chile, who at 1943-81 years gave birth to 55 children. As a result of the first 5 pregnancies, she gave birth to triplets, and exclusively male.
Most Birth
The record 38 births are claimed to be Elizabeth Greenhillies Abbots-Langley, c. Hertfordshire, UK. She had 39 children - 32 daughters and 7 sons.
The largest number of multiple births in one family
Maddalena Pomegranate from Italy (b. 1839) had triplets born 15 times.
There is also information about the birth on May 29, 1971 in Philadelphia, Pennsylvania, USA, and in May 1977 in Bagarhat, Bangladesh, 11 twins. In both cases, no child survived.
Most fertile pregnancies
Dr. Gennaro Montanino, Rome, Italy, claimed to have removed, in July 1971, the embryos of 10 girls and 5 boys from the uterus of a 35-year-old woman who was 4 months pregnant. This unique case of 15-fertility was the result of infertility pills.
9 children - the largest number in one pregnancy - were born on June 13, 1971 by Geraldine Broadrick in Sydney, Australia. 5 boys and 4 girls were born: 2 boys were stillborn, and none of the rest survived more than 6 days.
The birth of 10 twins (2 boys and 8 girls) is known from reports from Spain (1924), China (1936) and Brazil (April 1946).
The father with many children
The largest father in the history of Russia is Yakov Kirillov, a peasant from the village of Vvedensky, who in 1755 was presented to the court in connection with this (he was then 60 years old). The first wife of a peasant gave birth to 57 children: 4 times four, 7 times three, 9once twice and 2 times once. The second wife gave birth to 15 children.